Human toxicity from Covid-19 quick dwelling take a look at kits

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Human toxicity from Covid-19 quick dwelling take a look at kits

Am J Emerg Med. 2022 Jan 25

Kelly Johnson-Arbor, MD,a,b, Nicole Reid, BSN, EdM,b,c and Susan Smolinske, PharmDd,e

The persistence of the COVID-19 pandemic has necessitated the kind and standard availability of how to detect the COVID-19 virus in folk. COVID-19 checks, which were on the starting attach aside fully on hand in healthcare facility settings, are now manufactured for dwelling use within the build of quick diagnostic checks and veritably own a nasal swab, reagent acknowledge, and take a look at instrument (e.g., card or strip). These kits veritably involve application of reagent acknowledge to the take a look at instrument; within the presence of biological fabric obtained from the nasal swab, this initiates a chemical response that produces the take a look at consequence.

Multiple COVID-19 quick antigen dwelling take a look at kids, including those manufactured by Abbott (BinaxNOW™), Beckton, Dickinson and Company (BD Veritor™), Celltrion (Celltrion DiaTrust™), and ACON Laboratories (Flowflex™), own sodium azide as a component of the reagent acknowledge [[1], [2], [3]]. The reagent in some kits would maybe well presumably also own other constituents, including Triton-X, inorganic phosphate, and Pro-Clin 300. The latter formula are now not going to cause human toxicity if puny quantities are ingested, but they would maybe well also cause hypersensitive response symptoms or native irritation after ocular or dermal publicity. Then all all over again, sodium azide is well-known for its capacity to cause immoral ends up in folk, especially after oral exposures and doubtlessly including the ingestion of reagent acknowledge. Additionally, for the explanation that reagent acknowledge packaging would maybe well presumably also consist of ampules that allow for application of drops of acknowledge to the take a look at instrument, inadvertent ocular sodium azide exposures can occur if the ampule is unsuitable for an eyedropper.

Sodium azide is a water-soluble, tasteless, and odorless chemical that is generally damaged-down as a preservative agent [4]. It’s miles also stumbled on as a propellant in some vehicle airbags; upon affect, sodium azide ignites and transforms into hydrocarbon gases that cause airbag growth [5]. Even though data relating to acute sodium azide toxicity in folk are restricted, the chemical can cause extreme destructive events after oral publicity to slightly low doses. In one seek, sodium azide used to be administered at doses of 0.65 and 1.3 mg to wholesome and hypertensive folk (for a 70-kg adult, this corresponds to a dose of 0.01 and 0.02 mg/kg) [6]. Hypotension befell at present, inner 45–60 s in some matters, and lasted for 10–15 min. Whatever the autumn in blood pressure, reflex tachycardia used to be now not eminent, but an intensive description of alternative destructive events used to be now not equipped by the authors. Within the identical seek, one hypertensive discipline who received oral doses of 0.3 mg (or 0.004 mg/kg for a 70-kg particular person) skilled a substitute in blood pressure from 183/104 mmHg pre-treatment to 115/68 mmHg put up-treatment. Ingestion of better doses of sodium azide (>700 mg or 10 mg/kg) by adults is expounded to cardiac arrhythmias, metabolic acidosis, and dying [[7], [8], [9]].

The reagent fluid in many COVID-19 quick antigen dwelling take a look at kits contains sodium azide in concentrations of 0.0125–0.0946%, and inner most communication with take a look at kit manufacturers printed that the reagent fluid quantity in these kits is puny (0.3–0.625 mL) [[1], [2], [3]]. Thus, reagents with sodium azide concentrations now not as much as 0.09–0.095% veritably own extremely low quantities of sodium azide (0.04–0.08 mg), or well below the amount anticipated to cause transient hypotension in adults. Kits that bear reagent fluid with better sodium azide concentrations (better than or equal to 0.09%), including the BD Veritor™ and Celltrion DiaTrust™ testing programs, own approximately 0.3 mg of sodium azide [10,11]. Ingestions of this magnitude can consequence in hypotension, lowered conclude-organ perfusion, and syncope. Young of us would maybe well presumably also ride extreme destructive events after exploratory oral exposures to minimal quantities of the reagent alternate suggestions attributable to their smaller physique dimension and wishes to be monitored closely for hypotension or other sequelae after ingestion of even minute quantities of reagent fluids. For the explanation that onset of hypotension after oral publicity to sodium azide is quick, prolonged observation is seemingly pointless for folk who remain asymptomatic after reagent fluid ingestion. The treatment of symptomatic sodium azide intoxication is supportive in nature and comprises intravenous fluids and vasoactive medicines.

Whereas dwelling COVID-19 checks bear remained in transient offer all the scheme by most of the sizzling pandemic, the United States executive started offering free checks to its residents starting in mid-January 2022. Before this distribution of free checks, a large sequence of cases bright oral publicity to COVID-19 dwelling take a look at reagent fluid were reported to United States poison centers. From June 16, 2021 by January 19, 2022, the fetch webPOISONCONTROL® instrument received 153 reviews of human publicity to COVID-19 dwelling take a look at kits or reagents. Many of these cases were associated to no destructive outcomes, suggesting that exposures bright reagent fluid are now not going to cause fundamental human toxicity. The expanded access to dwelling checks will seemingly consequence in a additional extend in human exposures to the reagent fluids. Emergency physicians, pharmacists, and poison heart group would maybe well presumably also quiet preserve awareness of the doable toxicities associated to ingestion of the reagent fluids and can even be absorbing to residence patients who sing for care after exposures to the contents of COVID-19 quick antigen dwelling take a look at kits.

References

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9. Recount Okay.W., Ward N.E. Fatal azide-ended in cardiomyopathy presenting as acute myocardial infarction. Am J Cardiol. 1989 Oct 1;64(12): 830–831. [PubMed] [Google Scholar]

11. Celltrion Celltrion DiaTrust™ COVID-19 Ag dwelling take a look at healthcare provider instructions for use. 2022. https://www.fda.gov/media/153420/download Available at. Accessed 1.19.22.

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